Limited midwifery care for undocumented women in the Netherlands

Abstract

Background: Ethnic minority women in Western countries have poorer pregnancy outcomes compared to majority populations, and undocumented women are particularly vulnerable. We intended to assess whether midwives adjust their care if women are undocumented and have no health insurance. Methods: A retrospective matched cohort study in primary midwifery care practices in Amsterdam and Rotterdam, the Netherlands. Undocumented, uninsured women (N = 141) were matched with documented, insured ethnic minority women (N = 141). Information was extracted from patient records. Results: Undocumented women attended their first prenatal visit 5 weeks later in their pregnancy and received care elsewhere or disappeared from care more frequently (59.6 versus 34.3%). They frequently have an excess of 110% of the number of expected antenatal visits (32.4% versus 16.9%) and had a preterm birth more frequently (OR 4.59, 95% CI 1.43 to 14.72). Midwives were equally likely to follow referral guidelines in both groups. Undocumented women were more likely to give birth at home (OR 2.14, 95% CI 1.07–4.28) and less likely to receive maternity home care assistance (56.0 versus 79.7%). Conclusion: Although referral guidelines are generally followed by midwives, undocumented women are more at risk of adverse perinatal outcomes and inadequate care than documented ethnic minority women.

Keywords::

• ethnic groups
• illegal migrants
• midwifery
• pregnancy outcome

Acknowledgement

Many thanks to the students from the Midwifery Academies in Amsterdam and Groningen who worked hard to collect the data for this study: Bahareh Goodarzi, Carola Hartog, Marije van Barneveld, Roos de Boer, Marloes Faber, Maaike Scheerens. We also like to thank the midwifery practices that accommodated data collection and to Marianne Prins, the midwifery tutor who helped to organize the data collection.

Declaration of interest: None of the authors have competing interests to declare. No funding was obtained for this study.

Current knowledge on this subject

• Ethnic minority women in Western countries have poorer maternal and perinatal pregnancy outcomes compared to the majority populations.

• Among ethnic minority groups, undocumented women are particularly vulnerable.

What this study adds

• Among ethnic minority women, differences were compared in the content of primary midwifery care and pregnancy outcomes between undocumented pregnant women and documented women who originate from a similar geographical region.

• Higher rates of adverse perinatal outcomes were found among undocumented women than among documented ethnic minority women.

• No difference was found in compliance with referral guidelines by midwives but differences in other care factors were prevalent.